The machinery of medicine

Over the last few years, as electronic medical records have become the norm in hospitals, clinics, and doctors’ offices, clinicians have tried to come to terms with the computer. Is this machine demanding their attention at the expense of the patient? How does a doctor engage her patient while typing data into a template? The tools of medicine—from the stones that Neolithic humans honed into scalpels to the earliest stethoscopes that emerged in the 19th century to today’s sophisticated imaging devices—have changed the way physicians interact with their patients. And those tools are changing biomedical research as well.

At Yale and around the world such new technologies as 3D printing or biomedical engineering have advanced medical research. But scientists still rely on hunches, instinct, and serendipity as well as these tools. When an experiment in biomedical engineering yielded unplanned results, the scientists didn’t scrap their findings—they looked for a way to use what they’d found and voilà, a new approach to sunscreen. Another team tried to synthesize a compound found in a red sponge from the Caribbean to make a medicine to block HIV infection. It took eight or nine tries, and with each failed effort, they reevaluated and adjusted until they got it right. Physicians at Yale spent almost 10 years developing an artificial pancreas that would control insulin delivery for people with diabetes. Last summer they tried it out on a group of teenagers in New Haven, with dramatic results.

In this issue of Yale Medicine we take a broad view of the machinery of medicine to explore the ways in which physicians, scientists, and engineers work to advance both their understanding of the human body and how they apply that knowledge to clinical care.